The importance of spirituality as a strong factor in the healing process is being increasingly recognized both by physicians and other healthcare providers as well as by the patients and their relatives. When suddenly faced with a serious illness and its possible fatal outcome, a patient otherwise not so religious, sometimes turns to God for some difficult questions ( like why me ? ) and then finds support through his spiritual beliefs even outside the context of an organized religion. It is his own interpretation of the well being of his spiritual state that sustains him through the struggle that he goes through in fighting the illness.

As physicians we must ask ourselves these questions: What is our role beyond offering the diagnosis and therapeutic options for the patients? Should we try to understand the spiritual needs of our patients? How does our own spirituality affect the way we treat our patients? Should we incorporate spirituality in the treatment modalities that we offer? Does it make any difference in the outcome?

But, what is spirituality? Is it always a religious spirituality or can one have spirituality without religion ? As a Muslim, I feel that spirituality is recognition of God within us. Man was created by God, who had “blown his spirit into him”, but man, who was separated from God, tries to be connected to Him, like a child connected to his mother by an umbilical cord. As a physician, I feel that I am an instrument of God’s healing. I diagnose with the knowledge given by God. I dispense the medicines created by God (though it could have been discovered by a fellow human being) and after dispensing the medicine I ask God to make the medicine to work for my patients. If we explore the spirituality of our patients, we will find that illness brings a patient closer to God. The patient sees his physician not only as a healer but as a priest as well. He is not just a dispenser of medicine but also someone who has a special knowledge of healing. Thus, the expression “Doctor, you have saved my life”, knowing that the only actual savior is God.

Now as to the question why religion and where does religion fit into spirituality. I feel that the purpose of religion is to make us reflect and start asking questions like: Who created us? What is the purpose of our creation? What is our mission on earth? What is our duty toward ourselves, our fellow humans and our Creator? Hopefully the answers, when we find them, may modify our behavior.

There is no doubt that religion has influence on our health. In the book “Timeless Healing”, Benson cites studies showing the beneficial effects of religion. In 16 out of 18 studies, religion was cited as one which caused reduction in alcohol consumption in 6 out of 6 studies it helped reduce nicotine use, drug use was decreased in all 12 studies, there was decreased depression in 12 out of 17 studies, reduced blood pressure in 4 out of 5 studies and improved quality of life in 7 out of 9 studies while it reduced anxiety in 8 out of 11 studies.

Dr. Larry Dossey, in his book “Healing Words”, describes an experiment on prayer and healing. In 1988 at San Francisco General Hospital, 293 critically ill patients in coronary ICU were chosen and divided into 2 groups.

Group A: the patients who were prayed for by name by prayer makers who did not know the patients personally.

Group B: Patients who were not prayed for.

The results were interesting. Group A had fewer complications and less CHF, 2 ½ times less antibiotic usages and 1/5 less cardiac arrest. They also left the hospital earlier compared to Group B. Prayer makers were not told what to pray. Many used simple words such as “Lord have mercy on this patient” or “Thy will shall be done”.

A good physician goes beyond the signs and symptoms of disease but also other factors influencing that disease, including his social and spiritual state. For example, if the diagnosis is cirrhosis of the liver then he must go beyond and find if it is related to alcoholism and if so, what caused the patient to have alcoholism. I have seen both Diabetic Coma and hyperthyroidism precipitated by severe family stress. The physician is best equipped to offer sympathy, comfort and counseling during death, loss and mourning. Such offering by the physician has better effect on the patient’s ability to cope with such loss than any tranquilizer. We must treat our patients like we would like ourselves and our relatives to be treated.

In a recent article published in “The Lancet”, May 10, 2003, Rosenfield et al evaluated spirituality in terminally ill patients. One hundred sixty-eight such patients who were expected to live less than 3 months due to terminal cancer, were selected. The outcome, especially in relation to their understanding of the meaning of life and religion and their behavior toward the illness, was evaluated. According to their conclusions, spirituality as measured by inner peace and meaning of life, helped these terminally ill patients avoid despair, wanting to die or have suicidal tendencies as compared to similar patients without spirituality. Thus, Rosenfield recommended that “health care providers should incorporate psychological and spiritual elements into the palliative care of dying patients.

Hope is also a medicine. Physicians may find that sometimes disbelief leads to despair and hopelessness. By rediscovering a patient’s spirituality, a physician may be able to connect him to God and offer hope as an agent to conventional treatment. This will improve the compliance of the patient in the treatment offered to him. Our duty is to uncover the built in but hidden spirituality within us and our patients. This awareness can be achieved by silent meditation, exploring nature, religious chanting like mantra , zikr or reading sacred scriptures, listening to spiritual music and caring for those in need. Spirituality in music or the healing power of music depends on the music. According to Ghazali, a famous Muslim saint, “the music which increases spirituality and brings one closer to God is good music but the music which dulls the spirituality and diverts from remembrance of God is not so good”.

Are there any medical effects of meditation? According to El-Kadi, a Florida physician who has done extensive research on this, meditation lowers heart rate and blood pressure, relaxes smooth muscle, improves breathing and improves memory and certain words when chanting have an echoing effect and there are certain legislative effects of injunctions. This was also confirmed by La Forge in 1997. Quran , the Islamic scripture says, “Those who believe, whose hearts find peace in remembrance of God, for sure in the remembrance in God do hearts find peace” (13:28) . According to Prophet Mohammad, “there is a polish for everything and the polish for removing the rust of the heart is remembrance of God”. Now the question is: Does God listens only to the prayers of a certain faith or to everyone? According to the Quran, He listens to the prayers of everyone in need or in distress. “When my servants ask you about Me, tell them I am closer to them than their jugular vein. I listen to the prayers of each supplicant when he prays to Me. Let them listen to My call and believe in Me that he may be guided” (2:186).

In this disturbed world, there is a dire need for spirituality. It is the lack of spirituality which sometimes results in our misguided behavior. Dr. Martin Luther King said 40 years before Sept.11,2001 “ The technology has over taken Spirituality - we have now created guided missiles and misguided men”.

How do we increase our own spirituality? We must take time to pause and reflect upon who we are, what the purpose of our life is and what life means to us. We must observe the life and bounties of life. We must observe death or at least reflect upon death that it is a turning point in the journey of that person who dies and the people around him or her. We must conquer our self-destroying self. We must examine our relationship with God and if it is disturbed, try to mend that relationship. We must serve others in order to improve our own spirituality. Dr. Tagore, an Indian poet who received the Nobel Prize in 1930, wrote this: “I slept and dreamt that life was a joy. I woke and saw that life was a service. I acted and behold the service was a joy.” Thus, the dream becomes a reality when we perform service.

How do we dispense the gift of spirituality to our patients? We must take time to listen to them. We must befriend the patient and become a trusted partner in his healthcare. We must try to know what else is happening in his life. That includes not only his home but also his job and his relationship with others. We must try to talk to him about his own spirituality and try to convince him that God loves him even in these desperate moments and cares for him. We must offer hope for him, not just dismal statistics about the probability of outcome of certain diseases. We must encourage him to pray and pray with him or for him. The results of such efforts will be noticed. The patient will be motivated to get well. He will accept the negative outcome if there is any and he will take the bitter medicine willingly. His compliance will improve and he will thank you when he gets well. He will not complain if the medicine did not work and he will be at peace even at the time of death.

Once the , physicians who are healed, will become the instruments of healing as nothing is needed more in our lives than healing both for us and our patients. We as Physicians are weak human beings. We should stop playing God for others. We also need compassion for ourselves as well.

I end this article with this poem:

“Unwavering Love! in difficult times,Help me to attend to my own spiritMy headaches also need compassionTeach me how to offer kindness to parts of me that hurtRemembering Your great love for me,I can reach out and lovingly embrace myself.” (poet unknown)

Presented on May 11, 2003 at University of Texas, South Western Medical School in Dallas on May 22nd at St. Vincent Hospital, Indianapolis, and 34th annual convention of IMANA 2003.

SELECTED READING

Rosenfield et al “Effects of Spiritual Well Being on End of Life in Terminally Ill Cancer patients”. Lancet 2003, 361, 1603-1607